Provider Demographics
NPI:1932293545
Name:KISER, PAMELA E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:E
Last Name:KISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 WILLOW LAWN DR
Mailing Address - Street 2:STE 117
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3421
Mailing Address - Country:US
Mailing Address - Phone:804-288-8327
Mailing Address - Fax:804-282-3744
Practice Address - Street 1:1508 WILLOW LAWN DR
Practice Address - Street 2:STE 117
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3421
Practice Address - Country:US
Practice Address - Phone:804-288-8327
Practice Address - Fax:804-282-3744
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010332202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932293545Medicaid
VA224564OtherANTHEM
VA224564OtherANTHEM
VA017114C36Medicare PIN